Lipa Bank Inc

Take your photo using your camera *

The captured photo is embedded into the form and will be submitted together with your application.

Type of Application *

Updates from previous submission? *

Applicant Type *

First Name *

Middle Name *

Last Name *

Suffix

Civil Status *

Date of Birth *

Place of Birth (Municipality/City, Province) *

Sex *

Citizenship *

Spouse Information (if applicable — type N/A if not applicable)

Home Address (Unit#, Building/House#, Street, Subdivision/Barangay/District, Municipality/City, Province, Zip Code) *

Home Address Ownership *

Length of Stay in Location (years) *

Mother's Maiden Name

Company Name *

Position/Job Title *

Employer Address *

Employer Contact Number *

Length of Employment (years) *

Monthly Gross Income (₱) *

Other Source of Funds, please specify:

Years the Business has been in Operation *

Number of Branches *

Website/Social Media (Business) *

Indicate whether the business has:

Female Manager/s

Female head officer for operations/administrative services

Business Registration (check all that apply — type N/A in the row below if none)

Firm Size (total assets excl. land) *

Annual Sales or Revenue (₱) *

Employees (Full-time) *

Employees (Part-time) *

Top Trade References — Suppliers (type N/A in the row below if none)

Name of Top Suppliers	Goods Supplied/Services Rendered	Contact Person	Contact Number
				✕

Top Trade References — Customers (type N/A in the row below if none)

Name of Top Customers	Goods Purchased/Services Availed	Contact Person	Contact Number
				✕

Loan Amount Applied For (₱) (subject to bank approval) *

Tenor (months) *

Proposed Frequency of Repayment *

Loan Purpose (check all that apply)

Working capital (including receivables and inventory financing)

Construction/Development of real estate

Acquisition of real estate

Loan takeout/refinancing

Business expansion

Purchase of equipment/motor vehicles

Purchase of biological asset

Others, please specify:

Collateral/s and/or surety/ies offered

Loan secured by real estate (e.g. land, building)

Loan secured by movable property — Receivables & other claims to payment

Title documents (e.g. warehouse receipt, bill of lading)

Financial assets (e.g. deposits, tradable securities, company shares)

Intellectual Property

Equipment

Inventory

Others, please specify:

Loan backed by third party credit guarantee/continuing suretyship

Revenue

Asset Sale

Savings and/or Investment

Inheritance

Salary/Allowance

Others, please specify:

Existing Deposit and E-money Accounts (top 3 by outstanding balance — type N/A in the row below if none)

Existing Loans (top 3 by loan amount — type N/A in the row below if none)

Existing Credit Cards (top 3 by credit limit — type N/A in the row below if none)

I/We hereby confirm that all information and supporting documents provided herein are true, accurate and complete and I/we agree to notify the financial institution of any changes in any of the information supplied. The financial institution can withdraw or cancel any loan approval if any major information and supporting documents are found to be materially inaccurate. I/We authorize the financial institution to obtain relevant information as it may require concerning this application. I/We understand and agree that additional undertaking/declaration, not stated in this form, may be required by the financial institution. I/We hereby agree that this application shall be subject to applicable laws (BSP circulars, rules and regulations) and policies of Lipa Bank Inc.

Name of Financial Institution	Credit Limit	Outstanding Balance	Ownership
				✕

Third Party Credit Guarantor and/or Security Grantor (type N/A in the row below if none)

In compliance with the requirements of the Data Privacy Act (DPA), I/we hereby authorize and give my/our consent to Lipa Bank Inc. on the general use and sharing of information obtained in the course of any transaction/s pursuant to my/our banking relationship with it. Personal information and sensitive personal information may be collected, processed, stored, updated, or disclosed by the bank for legitimate bank-related purposes, to implement transactions which the borrower requests or authorizes, to comply with reporting obligations to government authorities, and to offer related products and services. I/We confirm that I am/we are aware that I/we have the right to access, update, dispute, block, or correct certain personal information, and understand this consent shall continue to be in effect until required by applicable banking laws.

Printed Name	Affiliation	Relationship with Borrower	Contact Information
				✕

I/We have read and understood and consent to be bound by all the terms and conditions stated above.

Loan Application

Spouse Information (if applicable — type N/A if not applicable)

Mother's Maiden Name

Business Registration (check all that apply — type N/A in the row below if none)

Top Trade References — Suppliers (type N/A in the row below if none)

Top Trade References — Customers (type N/A in the row below if none)

Existing Deposit and E-money Accounts (top 3 by outstanding balance — type N/A in the row below if none)

Existing Loans (top 3 by loan amount — type N/A in the row below if none)

Existing Credit Cards (top 3 by credit limit — type N/A in the row below if none)

Third Party Credit Guarantor and/or Security Grantor (type N/A in the row below if none)